We Have Moved!

Our orthopedic blog has now moved to our new home in The Center for Orthopedic & Spine Care at St. Joseph's Hospital Health Center! Please visit us at www.sjhsyr.org/care-that-moves-you to read the latest posts and stay up-to-date on all things relevant to orthopedic and spine care.

Contact us to subscribe to our new Care That Moves You Blog on www.sjhsyr.org/care-that-moves-you.

Thank you for your continued interest!

Richard Zogby, MD: 6/25/58 - 2/14/2013

By Dr. Seth Greenky

There are some people who are truly special - I was fortunate enough to personally know one. Rick and I were more then acquaintances, but less then close friends. I have known him for over 30 years. We shared the same medical school; the same Orthopedic residency; we practiced in the same city; and ultimately in the same practice.

Rick had many strengths and some are so obvious that they almost don't merit talking about - his surgical prowess being one. There are other traits that truly made him exceptional. TS Eliot wrote, "I never saw a wild thing sorry for itself. A bird will fall frozen dead from a bough without ever having felt sorry for itself." Through out his illness that extended over 10 years he never complained. It wasn't for lack of pain; it wasn't lack of emotional turmoil; it wasn't because of lack of frustration - it was his inner strength, his grasp of the important aspects of everything.

He took time to "smell the roses" and share the smell with those around him. He would greet his patients, his colleagues, office staff, hospital staff, even strangers with equal respect and warmth. He was a mentor in so many ways to so many people - surgical to residents, a visionary and leader for our group (Syracuse Orthopedic Specialists), and a courageous example to all of us. His family was the epicenter for him and the strength that sustained him.

What begins as a  ripple when a small pebble is dropped into a pond quickly grows into larger ripples that cascade outwardly until they reach the confines of the shoreline. Such was the impact that Rick Zogby had on the lives of everyone with whom he interacted. His actions impacted individuals far beyond those he physically touched through this ripple effect; the epitome of the Butterfly Effect. Every single thing he did mattered; to those who knew him personally, as well as to those who experienced a ripple of an action from him.

A beautiful and wonderful man is no longer with us in body, but in spirit he will live on in the hearts of all who knew him. I myself feel most fortunate that I took the time to become his colleague and his friend.

How appropriate it is that the beam that supports the new St Josephs OR was signed in memory of Rick Zogby - a physical representation of a life of strength and accomplishment.

Shoulder Arthritis

By Dr. Brett Greenky                                                                                         The Center for Orthopedic & Spine Care @ St. Joseph's Syracuse Orthopedic Surgeons, PC

                                                                                                             

The shoulder joint is really made up of two Joints: The AC Joint and the Glenohumeral Joint. The AC joint is so named because the Acromion and the Clavicle touch together here. The Acromion is part of the shoulder blade. The AC joint can and does become arthritic. Spurs develop underneath the AC joint and these spurs can agitate the tendons of the rotator cuff. The rotator cuff tendons rub back and forth underneath the AC joint when the shoulder moves. The arthritic spurs of the AC joint can impinge on the rotator cuff tendon during shoulder motion. The resultant rotator cuff tendonitis is the most common cause of shoulder pain in adults over 40.

The Glenohumeral Joint (GHJ) is the main “ball and socket” part of the Shoulder. Arthritis of the ball and socket (GHJ) part of the shoulder is a less common affliction than AC joint arthritis. Many patients with mild to moderate degrees of (GHJ) arthritis can be treated with medications, activity modification and physical therapy or home based exercises. The purpose of these exercises is to that tone the rotator cuff muscles. When toned these muscles can help reduce the amount of rubbing in the GHJ. It is when the GHJ arthritis progresses to the severe stage that these techniques tend to no longer be adequate and total shoulder replacement  (TSR) surgery is considered. Since patients do not need to walk on the shoulder joint, severely symptomatic shoulder arthritis comes late in the disease progression. As a result, most patients who seek treatment for severely symptomatic shoulder arthritis are already at the stage when TSR is the only treatment to afford dramatic relief.

Total Shoulder Replacement (TSR) has a high success rate in reducing or eliminating shoulder arthritis pain. In general the operation is easier to navigate for the patient when compared to Total Hip or Total Knee replacement surgery since the Shoulder is a non-weight bearing joint. The operation is however requires a one to two day hospital stay and some postoperative physical therapy.  A return to near normal function requires a well functioning rotator cuff. Much of the post operative treatment is directed to the strengthening of the rotator cuff muscles which often atrophy during the period of worsening arthritis. Since a functioning and intact rotator cuff is essential for traditional TSR surgery to be successful, the joint replacement specialist may need to do additional preoperative tests (MRI scan) to check the patient’s rotator cuff condition.

A special version of TSR is available for the patient with shoulder joint arthritis who does NOT have a functioning rotator cuff. This operation is called Reverse Shoulder Replacement. The operation reverses the polarity of the ball and socket of the shoulder thus explaining the name. This novel technique allows for pain reduction in the rotator cuff deficient patient but it does not restore the function of the rotator cuff itself. Patients without an intact rotator cuff are usually unable to elevate their arm much above the waist.

Dr. Brett Greenky the Co-director of the Joint Replacement Program at St. Joseph's Hospital. He is
a Board Certified Orthopedic Surgeon specializing in hip, knee, shoulder arthritis, reconstruction/surgery, minimally invasive hip and knee replacement, anterior approach hip surgery and revision hip/knee joint surgery.

Dr. Greenky is an Associate Professor of Orthopedics at SUNY Upstate Medical College and is the founder of Operation Walk Syracuse and Co-Executive Director.

Dr. Greenky completed his undergraduate studies at Northwestern Universityand received his M.D. from SUNY Upstate Medical Center. For more information on Dr. Greenky, visit http://ow.ly/ibztU.

Orthopedics: What treatment is right for you?

By Glenn Axelrod, MD

The Center for Orthopedic & Spine Care @ St. Joseph's
Syracuse Orthopedic Surgeons, PC

Orthopedic surgery is a surgical specialty which deals with diagnosis and treatment of medical conditions involving bone, muscle, and joints.  Although it is a surgical specialty, the majority of patient can be treated non-operatively; we refer to that as conservative treatment.  The conditions may be traumatic as well as non-traumatic.  Most surgical procedures are considered to be elective, meaning that surgery is likely to lead to a better outcome than non-operative treatment, but that it is not absolutely medically necessary.

Understanding the above explanation helps patients more actively participate in their treatment plan.  Beware of the surgeon who insists you need a hip replacement or need an anterior cruciate ligament reconstruction.

One of the things that attracts physicians to become orthopedic surgeons is the variety of conditions seen and the many treatment options of dealing with each of these problems. It is important that your orthopedist individualizes the treatment of your condition.  The treatment should take a number of factors into consideration including gender, age, activity level (i.e., sports), weight, time availability (i.e., physical therapy), etc. In addition, the expectations of the surgery and the post operative course requirements must be discussed and accepted by both you and the physician.

Here are a couple of examples to help demonstrate the individualization of treatment. The first would be a forty-five year old weekend athlete who sustains an anterior cruciate ligament tear; that individual enjoys biking, swimming, and occasional jogging but does not play any high energy sports.  This patient should probably not be treated the same way as a fifty-five year old aggressive athlete who skis, plays tennis, and basketball. The former would probably do well with a rehabilitation program; the latter would probably want an anterior cruciate reconstruction. 

Another example would be a seventy five year old with significant knee arthritis who is relatively sedentary, has pain only when walking for distances and who has responded well to steroid injections given once or twice a year. This patient will probably be content and not be treated the same as the fifty-five year old with moderately severe arthritis who cannot go for walks because of severe knee pain and who has not responded well to medications, injections, physical therapy and is generally unhappy with their quality of life.  The seventy-five year old will probably opt for continued conservative treatment whereas the fifty-five year old will most likely want to consider knee replacement surgery.

Dr. Glenn Axelrod is a Board Certified Orthopedic Surgeon specializing in sports medicine/arthroscopy, knee replacements, and general orthopedics. Dr. Axelrod has been in practice since 1982 and is a member of the American Academy of Orthopedic Surgeons, New York State Medical Society, and Onondaga County Medical Society.

Dr. Axelrod completed his undergraduate and medical studies at the University of Rochester and completed his residency at University of Rochester/Strong Memorial Hospital. For more information on Dr. Axelrod, visit http://www.sjhsyr.org/723-Glenn-Axelrod.

Arthroscopic Rotator Cuff Surgery

By Todd C. Battaglia, MD, MS

The Center for Orthopedic & Spine Care @ St. Joseph's
Syracuse Orthopedic Surgeons, PC

Rotator cuff tears are one of the most common causes of shoulder pain and dysfunction in the adult shoulder, and are one of the most frequent indications for shoulder surgery. Despite its ubiquity, however, there is no such thing as a “standard “rotator cuff repair. In fact, there are two completely different repair techniques used today – the more traditional “open” repair which utilizes a 3-5 cm incision to directly visualize and fix the rotator cuff, and “arthroscopic” repair, which utilizes a camera to repair the tendons through very small incisions. Arthroscopic cuff repair is a relatively new technique, first popularized approximately 15 years ago.

Initially, open repair held one distinct advantage, in that repair strength was better than that achievable with the early available arthroscopic equipment. However, improvements in arthroscopic techniques and technology have progressed to the point that repair strength is at least as good, and with some methods, better, than open techniques. In addition, arthroscopic repair offers a number of distinct benefits. First, for open repair, a portion of the deltoid muscle must be detached for adequate exposure, and then repaired at the conclusion of the surgery. This adds to pain, increases healing requirements, and leads to the potential post-operative complication of deltoid dehiscence (splitting open after repair). Conversely, the small incisions used for arthroscopy do not require any detachment of the deltoid. Second, open techniques allow no visualization of the biceps, labrum, joint surfaces or other structures inside the joint that are commonly abnormal in conjunction with rotator cuff tears. Arthroscopy allows visualization and concurrent treatment of all these structures. Third, only arthroscopy allows assessment and treatment of partial thickness tears without disrupting the whole tendon, particularly those on the deep (joint-side) surface of the tendon. In open repairs, the cuff is viewed only from the superficial (bursal) surface, and undersurface tears will not ever be seen. Fourth, and most critically, arthroscopy provides complete visualization of the entire rotator cuff - this permits a much more thorough assessment of the tear pattern, and allows the surgeon to more accurately determine the best strategy for a complete and tension-free repair.

With each passing year, fewer and fewer rotator cuff tears are repaired using open techniques.  In fact, for today's shoulder specialists, there are almost no rotator cuff tears that cannot be repaired arthroscopically. Interestingly, it is sometimes offered that some tears are “too large” or “too complex” for arthroscopic repair. This is false - such tears are precisely the ones best suited for arthroscopic repair – using the camera, they can be seen better and repaired more accurately and strongly.

Dr. Battaglia is a Board Certified Orthopedic Surgeon. He specializes in sports medicine, arthroscopic & reconstructive surgery of the knee & shoulder, ACL and knee ligament reconstruction, meniscus surgery, cartilage regeneration/restoration, rotator cuff injuries, shoulder instability/dislocations, clavicle and AC joint injuries and shoulder arthritis. Dr. Battaglia received his M.D. from SUNY Buffalo and MS from University of Virginia. For more information on Dr. Battaglia, visit http://ow.ly/hrhhD.

St. Joseph's Health Musculoskeletal Minute

Welcome to another edition of St. Joseph's Health Center's Musculoskeletal Minute! This video blog features doctors from St. Joseph's Hospital Health Center in Syracuse, NY, speaking on orthopedic topics of interest. You will see a new video blog out every few weeks.

Dr. Seth Greenky, chairman of Orthopedic Surgery at St. Joseph's Hospital Health Center, speaks on partial knee replacements - specifically, unicompartmental knee replacement.




Dr. Greenky is Board Certified in Orthopedic Surgery and is an Assistant Clinical Professor.

Education: MD, SUNY Health Science Center, BA, Biology, Northwestern University

Internship: SUNY Health Science Center

Residency: SUNY Health Science Center

Fellowship: Cleveland Clinic Foundation, Adult Reconstructive Surgery

Areas of Expertise: Hip, Knee, Shoulder Arthritis Reconstruction/Surgery, Minimally invasive hip and knee replacement, Revision hip/knee joint surgery